Rifaximin: A Nonabsorbed Antimicrobial in the Therapy of Travelers’ Diarrhea

DuPont, Herbert L.; Ericsson, Charles D.; Mathewson, John J.; Palazzini, E; DuPont, Margaret W.; Jiang, Zhi‐Dong; Mosavi, Amir; Cabada, Francisco J. de la

doi:10.1159/000007580

Cited by 83 publications

(60 citation statements)

References 24 publications

(34 reference statements)

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“…Moreover, in all four RCTs on the use of rifaximin for the treatment of travelers' diarrhea, the rates of adverse events in the rifaximin-treated patients were not different from those in the ciprofloxacin-or placebo-treated patients [Taylor et al 2006;Steffen et al 2003;Dupont et al 2001Dupont et al , 1998]. …”

Section: Travelers' Diarrheamentioning

confidence: 91%

“…Although a variety of bacterial, viral, and parasitic organisms can cause travelers' diarrhea, diarrhea-producing E. coli predominates. There have been four randomized controlled trials (RCTs) that demonstrated the efficacy of rifaximin for the treatment of travelers' diarrhea [Taylor et al 2006;Steffen et al 2003;Dupont et al 2001Dupont et al , 1998 (Table 1). The primary endpoint in these trials was the time to the last unformed stool (TLUS), defined as the time from the first dose of medication to the passage of the last unformed stool, after which the patient already feels well.…”

Section: Travelers' Diarrheamentioning

confidence: 99%

“…An earlier dose-finding RCT with four treatment arms was performed in 72 travelers to Mexico; no significant differences in TLUS were shown among the 5-day courses of rifaximin (200, 400, and 600 mg three times a day) and trimethoprim-sulfamethoxazole (TMP-SMX; 160/ 800 mg twice a day) [Dupont et al 1998]. Unexpectedly, a trend of a shorter TLUS with the administration of 200 mg rifaximin three times a day was shown.…”

Section: Travelers' Diarrheamentioning

confidence: 99%

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Rifaximin for the treatment of acute infectious diarrhea

Hong

Kim

2011

Therap Adv Gastroenterol

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Rifaximin is a nonabsorbable rifamycin derivative with an excellent safety profile and a broad spectrum of antimicrobial activity against a variety of enteropathogens causing acute infectious diarrhea. After oral ingestion, its bioavailability is known to be less than 0.4%, and it has a low potential for significant drug interactions. In the treatment of travelers' diarrhea caused by noninvasive diarrheagenic Escherichia coli, it has been demonstrated that rifaximin significantly shortens the duration of diarrhea and has an efficacy similar to that of ciprofloxacin. Moreover, according to two randomized placebo-controlled trials, prophylactic treatment with rifaximin reduced the risk of developing travelers' diarrhea by more than 50% compared with the placebo group. For the treatment of acute diarrhea unrelated to travel, a short course of rifaximin significantly reduced the duration of diarrhea, and its overall efficacy was comparable to that of ciprofloxacin. The discrepancy between the in vitro and in vivo antimicrobial activities of rifaximin, however, and the clinical implication of the rapid appearance of bacterial resistance, must be further elucidated. In conclusion, this gut-selective antibiotic seems to be a promising option for the treatment of acute infectious diarrhea secondary to noninvasive E. coli and also appears to be effective in chemoprophylaxis for travelers' diarrhea.

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Section: Travelers' Diarrheamentioning

confidence: 91%

Section: Travelers' Diarrheamentioning

confidence: 99%

Section: Travelers' Diarrheamentioning

confidence: 99%

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Rifaximin for the treatment of acute infectious diarrhea

Hong

Kim

2011

Therap Adv Gastroenterol

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“…Four major studies assessing the efficacy of rifaximin in the treatment of traveler's diarrhea have been conducted in Mexico, Guatemala, Kenya, and Jamaica (35,41,88,153). Compared to placebo, administration of either 200 mg or 400 mg three times daily was associated with improvement in the duration of diarrhea (88,153), whereas equivalency with ciprofloxacin and superiority to TMP-SMX have also been shown.…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Prevention and self-treatment of travelers' diarrhea

Diemert

2002

Primary Care: Clinics in Office Practice

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“…To resolve the problem of this increase in resistance, the activities of new antimicrobial agents should be studied. Rifaximin is a nonabsorbable antibiotic (2,5,6) achieving concentrations of 4,000 to 8,000 g/g in feces, with a common therapeutic dosage being 800 mg divided in two oral administrations (7). The main aim of this study was to evaluate the in vitro activity of rifaximin against enteropathogens isolated as a cause of traveler's diarrhea.…”

Section: In Vitro Activity Of Rifaximin Against Enteropathogens Produmentioning

confidence: 99%

In Vitro Activity of Rifaximin against Enteropathogens Producing Traveler's Diarrhea

Sierra

Ruiz

Navia

et al. 2001

Antimicrob Agents Chemother

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Nowadays, around 40 to 60% of Spanish travelers to developing countries develop diarrhea (4). Different enteropathogens have been associated with the development of traveler's diarrhea. The levels of prevalence of these enteropathogens as a cause of traveler's diarrhea are 42% for diarrheagenic Escherichia coli, 19.4% for Shigella spp., 3% for Salmonella spp., 2% for Campylobacter spp., 2% for Yersinia spp., 2% for Aeromonas spp., and Ͻ2% for others (4).Infectious diarrhea is usually a self-limited disease lasting a few days and does not require antibiotic therapy. In some cases, antimicrobial therapy is recommended (2); however, high levels of resistance to several antimicrobial agents have been described. To resolve the problem of this increase in resistance, the activities of new antimicrobial agents should be studied. Rifaximin is a nonabsorbable antibiotic (2, 5, 6) achieving concentrations of 4,000 to 8,000 g/g in feces, with a common therapeutic dosage being 800 mg divided in two oral administrations (7). The main aim of this study was to evaluate the in vitro activity of rifaximin against enteropathogens isolated as a cause of traveler's diarrhea.MICs of several antimicrobial agents for 177 enteropathogens (Table 1) were determined by the agar dilution method according to guidelines of the National Committee for Clinical Laboratory Standards (8). E. coli ATCC 29522 was used as a quality control strain.MICs at which 50 and 90% of the isolates tested were inhibited (MIC 50 s and MIC 90 s, respectively) and the percentages of resistance were calculated for each antimicrobial agent used in this study and are shown in Table 1.The conventional antimicrobial agents, such as ampicillin, cotrimoxazole, tetracycline, and chloramphenicol, showed no or very little activity against the enteropathogens producing traveler's diarrhea. A MIC 90 of ampicillin of greater than 128 g/ml was observed against all of the microorganisms, whereas the MIC 90 s of tetracycline and trimethoprim for all the microorganisms were Ն16 g/ml. Only nalidixic acid and ciprofloxacin showed MIC 90 s of Ͻ16 and 0.06 g/ml, respectively, for all the enteropathogens tested, with the exception of Campylobacter jejuni, for which MIC 90 s were Ͼ256 and 32 g/ml, respectively. The MIC 90 s of chloramphenicol for the different microorganisms were in a range from 8 to Ͼ128 g/ml.Cotrimoxazole and ampicillin have been widely used to treat traveler's diarrhea (3,11,12), and the long use and sometimes the misuse of these antibiotics have been associated with the increase of resistance levels (1, 10, 12).MIC 50 s and MIC 90 s of rifaximin and rifampin were very similar. MICs of rifaximin ranged from 4 to 8 and from 4 to 16 g/ml, and MICs of rifampin ranged from 4 to 16 and from 8 to 16 g/ml, for all tested bacteria except Yersinia enterocolitica and C. jejuni.In particular, the MIC 50 and MIC 90 of rifamixin of 64 and 128 g/ml, respectively, were observed for Y. enterocolitica and a value of Ͼ128 g/ml for both the MIC 50 and MIC 90 was achieved for C. jejuni....

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Rifaximin: A Nonabsorbed Antimicrobial in the Therapy of Travelers’ Diarrhea

Cited by 83 publications

References 24 publications

Rifaximin for the treatment of acute infectious diarrhea

Rifaximin for the treatment of acute infectious diarrhea

Prevention and self-treatment of travelers' diarrhea

In Vitro Activity of Rifaximin against Enteropathogens Producing Traveler's Diarrhea

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